Angiotensin II for Refractory Vasodilatory Shock

Kenneth L. Smith, Mercer University College of Pharmacy

Vasodilatory shock is a medical emergency where the organs and tissues undergo a decrease in perfusion which can lead to organ failure and death if not treated immediately.  In this syndrome, a drop in blood pressure can occur despite preserved cardiac output. [1]  When intravenous fluid resuscitation fails to restore blood pressure, few choices are available other than vasopressors such as catecholamines (or other sympathomimetics) in addition to vasopressin.[2] However, these can be toxic at highdoses, and when these options fail, prognosis is considered poor.[3] Angiotensin II is a component of the renin-angiotensin –aldosterone-system (RAAS) which causes the release of anti-diuretic hormone (ADH), also known as vasopressin, from the posterior pituitary.[4] This leads to vaso-constrictive effects that can increase blood pressure. Consequently, use of angiotensin II for vasodilatory shock has been considered to provide a more natural physiological response to treat this serious condition.[5]

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